格列美脲与格列本脲治疗2型糖尿病疗效的系统评价

目的系统评价格列美脲与格列本脲治疗T2DM的疗效。方法计算机检索PubMed、万方等数据库从建库至2010年12月间的有关文献。按Cochrane系统评价的方法评价纳入研究的质量,使用Review Manager4．2软件进行荟萃分析。结果共纳入9个随机对照试验。结果显示：格列美脲在降低HbA1c[P=0．08,加权均数差（WMD）=-0．18,95％CI（-0．39,0．02）]、FPG[P=0．06,WM=-0．46,95％CI（-0．94,0．01）]、餐后血糖[P=O．73,WMD=-0．16,95％CI（-1．08,0．76）]、TC[P=0．22,WMD=-0．2,95％CI（-0．51,0．12）]和TG[P=0．06,WMD=-0．30,95％CI（-0．61,0．01）]方面与格列本脲无差异;在相同血糖水平下,格列美脲组FIns[P〈0．05,WMD=-0．83,95％CI（-1．21,0．45）]及餐后胰岛素[P〈0．05,WMD=-5．94,95％CI（-8．79,-3．10）]升高程度低于格列本脲组;低血糖发生率格列美脲组低于格列本脲组[P〈0．05,RR=0．66,95％CI（0．53,0．81）];在降低BMI方面格列美脲优于格列本脲[P=0．02,WMD=-1．49,95％CI（-2．7,-0．27）]。结论与格列本脲相比,格列美脲在降低血糖的同时,还能改善胰岛素抵抗及减轻体重,且低血糖发生率低,是安全有效的治疗T2DM的药物。     

Thermal-induced effects on vein tissue – A basic ex-vivo investigation for EVLT

ObjectivesDifferent procedures of endoluminal thermal treatment of saphenous vein (varicosis) are under investigation in clinical trials. While systems for heat induction like radiofrequency or laser are employed, little is known about their fundamental effects on venous tissue.MethodsAn ex-vivo model using the subcutaneous foot vein from recently slaughtered cows was developed for an experimental evaluation of endoluminal thermal procedures for the occlusion of saphenous vein. Primary and acute effects after thermal experiments and initial mechanisms of structural changes of the vessels could be studied within this model. First, veins were extracted and sliced into pieces of a length of 5 cm, each. Its lumen diameter as well as its wall thickness were measured. Then, the tissue was broiled in water at different constant temperatures (65 °C<T<85 °C) for a certain time (15 s<t<300 s). Afterwards, the tissue dimensions were measured again and changes were calculated. Second, native and heated tissue samples were put into a tension measuring system to determine the elasticity by stretching the samples and quantifying the required force until rupture.ResultsHeated vein tissue showed a shrinkage of up to 35% in length. While the outer diameter showed shrinkage as well, the vein wall thickened up to 135%. Furthermore, the tissue whitened due to coagulation and became rigid. The elasticity was determined by measuring a stretching capability of 20 mm in denatured tissue compared to 40 mm in native tissue. Similarly, the maximum force required for rupture decreased from 120 to 60 N.ConclusionThis study clearly proved that the mechanical properties of the venous tissue change due to heating. As a side effect, adjacent tissue (e.g. nerves) may be affected as well, which could be responsible for patient's pain after endoluminal thermal treatment. The optimum parameter for a maximum change of the vein wall could be estimated from these data to improve clinical procedures.     

吲哚美辛对β淀粉样蛋白1-42诱发BV-2细胞产生炎性介质的抑制作用

目的研究吲哚美辛对β淀粉样蛋白1-42（Aβ1-42）刺激小胶质细胞释放炎性介质一氧化氮（NO）及白细胞介素-1β（IL-1β）的抑制作用。方法应用高度纯化的BV-2小胶质细胞作为体外小胶质细胞模型，应用不同浓度吲哚美辛（10^-9，10^-8，10^-7，10^-6，10^-5mol／L）与20μmol／LAβ1—42单独或同时培养12h，测定细胞上清NO及IL，1β含量；RT—PCR法测定BV-2细胞iNOSmRNA及IL-1βmRNA的表达。结果吲哚美辛单独作用对BV-2细胞产生NO、IL-1β及iNOSmRNA、IL-1βmRNA表达无明显作用。Aβl—42可以刺激BV-2细胞产生NO及IL-1β，并增加iNOSmRNA及IL-1βmRNA表达，这种作用均可被吲哚美辛所抑制，在吲哚美辛浓度为10^-7～10^-5mol／L时抑制作用较为明显。结论在体外吲哚美辛可以降低Aβ1—42介导的BV-2细胞iNOSmRNA及IL-1βmRNA表达，从而减少NO及IL-1β的产生，上述抑制作用可能参与了吲哚美辛在阿尔茨海默病治疗中的神经元保护机制。     

The efficacy of CD3 x CD19 bispecific monoclonal antibody (BsAb) in a clonogenic assay: the effect of repeated addition of BsAb and interleukin-2

To evaluate the potency by which human T cells are targeted and activated by bispecific monoclonal antibodies (BsAbs) to lyse tumor cells, a clonogenic assay was developed. The efficacy of a CD3 x CD19 BsAb binding to both the CD3 T-cell antigen and the CD19 B-cell antigen was already proven in 51Cr-release assays and in 3-day activation cultures. To achieve more quantitative results, a 14-day clonogenic assay, based on limiting-dilution, was performed for the determination of the initial and residual number of clonogenic units obtained with a CD19+ pre-pre-B acute lymphoblastic leukemia (ALL-B) cell line. Elimination of up to 5 logs of ALL-B cells by freshly isolated peripheral blood mononuclear cells (PBMCs) cultured with BsAb plus interleukin-2 (IL-2) could be detected. The presence of human IgG did not abolish the effect. Repeated addition of each of the two agents was necessary, because a single treatment produced only a 1- to 2-log kill. CD3 monoclonal antibody and IL-2 stimulation ("lymphokine-activated killer cell" conditions) resulted in only a 2-log kill. The number of T cells proved critical in lysis of ALL-B cells, with a 5-log kill using a T-cell:B-cell ratio of 3:1 but with only a 1-log kill using a ratio of 1:1. PBMCs isolated from patients with non-Hodgkin's lymphoma, both in relapse or remission, proved to be as competent as those from healthy donors in removing ALL-B cells. This clonogenic assay shows the importance of repeated administration of CD3 x CD19 BsAb and IL-2 and offers the possibility to compare it with other therapies in B-cell malignancy.     

潜伏梅毒患者临床相关因素分析

目的：探讨潜伏梅毒患者与临床相关因素的关系。方法：收集并整理573例梅毒患者中361例潜伏梅毒患者临床资料,对潜伏梅毒患者的年龄、性别、病期、就诊原因、血清学检验及诊治情况的特征进行统计学分析。结果：潜伏梅毒占梅毒发病率的63%,21~50岁性活跃期的人群发病率较高,老年人病程较长,均为各种筛查确诊而发现;潜伏梅毒RPR滴度较低,滴度在1∶8以下占96.12%,潜伏梅毒治疗血清阴转率偏低,多出现血清固定。结论：潜伏梅毒由于受到其隐蔽的临床特征的影响,难以早期发现,潜伏梅毒可以传播患者周围的人群,而且其潜在作用对患者健康危害较大。     

髂-股动脉多层螺旋CT测量

目的:采用16层螺旋CTA对髂-股动脉进行测量,为经髂-股动脉介入诊疗提供影像学数据。方法:收集2010年6月～9月符合要求的连续病例350例,按照年龄21～40岁、41～60岁、61～89岁分为A、B、C组。经肘正中静脉注射对比剂后,用16层螺旋CT进行包括盆腔区的增强扫描,薄层重建图像用容积再现技术对髂-股动脉进行三维重建。测量动脉分叉到髂嵴连线、股骨头上缘连线的垂直距离及动脉分叉夹角。相同性别不同年龄组间采用单因素方差分析,相同年龄组不同性别采用两独立样本t检验,不同侧别间采用配对样本t检验。结果:腹主动脉分叉、左右髂总动脉分叉、左右股总动脉分叉到股骨头上缘连线的垂直距离男性A组分别为(132.5±12.8)mm、(87.1±14.9)mm、(88.8±11.3)mm、(43.4±13.7)mm、(41.5±15.0)mm,B组为(126.5±11.6)mm、(84.8±14.2)mm、(89.1±12.9)mm、(44.3±10.1)mm、(46.2±10.1)mm,C组为(115.6±10.7)mm、(80.3±14.3)mm、(82.3±13.6)mm、(39.1±10.0)mm、(40.4±10.0)mm,女性A组分别为(135.4±12.1)mm、(91.3±15.1)mm、(97.4±14.1)mm、(36.5±10.3)mm、(36.2±10.3)mm,B组为(129.8±12.7)mm、(92.7±12.5)mm、(96.0±13.3)mm、(36.5±10.8)mm、(35.8±10.9)mm,C组为(121.2±13.1)mm、(84.0±11.3)mm、(86.3±11.4)mm、(36.4±12.2)mm、(36.9±11.0)mm。除男性左髂总动脉分叉、女性左右股总动脉分叉到股骨头上缘连线的垂直距离外,不同年龄组间差异均有统计学意义(P<0.05)。腹主动脉分叉夹角、左右髂总动脉分叉夹角男性A组分别为(38.2±5.8)°、(26.6±16.9)°、(30.5±10.8)°,B组为(38.1±11.3)°、(25.3±10.8)°、(24.8±11.2)°,C组为(45.1±16.5)°、(25.8±12.5)°、(25.6±13.2)°,女性A组分别为(46.9±10.9)°、(28.2±13.5)°、(28.9±10.2)°,B组为(40.7±11.2)°、(20.3±10.3)°、(21.6±9.7)°,C组为(45.1±11.2)°、(21.0±9.9)°、(27.0±12.1)°,男女腹主动脉分叉夹角、男性左右髂总动脉分叉夹角不同年龄组间差异有统计学意义(P<0.05)。两侧对比三组的髂总动脉分叉点至股骨头上缘连线垂直距离差异均有统计学意义(P<0.05)。结论:16层螺旋CTA可对髂-股动脉进行准确测量,为介入诊疗提供数据。     

Transient hyperthyroidism after surgery for secondary hyperparathyroidism: a common problem

Background

Postoperative hyperthyroidism occurs in approximately one third of patients following parathyroidectomy due to primary hyperparathyroidism (PHP), but has only rarely been described in secondary hyperparathyroidism (SHP). The frequency, course, and laboratory markers of postoperative hyperthyroidism in SHP remain unknown. Our purpose was to evaluate the frequency and the clinical course of postoperative hypcrthyroidism following surgery of SHP and to determine the diagnostic value of thyroglobulin in this setting.

Material and Methods

A total of 40 patients undergoing parathyroidectomy because of SHP were included in this study. Thyroid stimulating hormone (TSH), free triiodothyronine (fT3), free thyroxine (fl4), and thyroglobulin (Tg) were determined one day before and on day 1, 3, 5, 10, and 40 after surgery. At each of these visits patients were clinically evaluated for signs or symptoms of hyperthyroidism.

Results

Biochemical evidence of hyperthyroidism was evident in 77% of patients postoperatively despite of preoperatively normal serum levels. TSH dropped from 1.18 ± 0.06mU/L to 0.15 ± 0.07mU/L (p = 0.0015). Free triiodothyronine (fT3) and fT4 levels increased from 2.86 ± 0.02ng/L and 10.32 ± 0.13ng/L, respectively, to their maximum of 4.83 ± 0.17ng/L and 19.35 ± 0.58ng/L, respectively. Thyroglobulin levels rose from 3.8 ± 0.8ng/mL to 111.8 ± 45.3ng/mL (p < 0.001). At day 40 all thyroid related laboratory values were within normal range. Correlation analysis of postoperative values revealed significant correlations for lowest TSH (r = -0.32; p = 0.038), and highest fT3 (r = 0.55; p < 0.001) and fT4 levels (r = 0.67; p < 0.001) with Tg.

Conclusion

Transient hyperthyroidism is frequent after parathyroidectomy for SHP with Tg being a suitable marker. Awareness of this self-limiting disorder is important to avoid inappropriate and potentially harmful treatment.